<%@page contentType="text/html" pageEncoding="UTF-8"%>

<jsp:useBean id="model" scope="session" class="model.WebModel"/>
<%@page session="true"  errorPage="PaginaError.jsp" %>




<%
    model.init(application);


    request= (HttpServletRequest)pageContext.getRequest();
    String BASEURL= request.getContextPath();
    String CONTROLLER=BASEURL + "/controller";

 %>

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"
   "http://www.w3.org/TR/html4/loose.dtd">

<html xmlns="http://www.w3.org/1999/xhtml" dir="ltr" lang="en-US" xml:lang="en">
<head>
    <meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
    <meta http-equiv="X-UA-Compatible" content="IE=EmulateIE7" />
    <meta http-equiv="cache-control" content="no-cache" />
    <meta http-equiv="expires" content="0" />
    <title>Request & Send </title>
    <script type="text/javascript" src="SCRIPS/script.js"></script>
      <script type="text/javascript" src="SCRIPS/form5.js"></script>
    <link rel="stylesheet" href="CSS/style.css" type="text/css" media="screen" />
    <link rel="stylesheet" type="text/css" media="all" href="CSS/screen5.css" />
    <link rel="stylesheet" type="text/css" media="print" href="CSS/print5.css" />
        
<style type="text/css" media="all">
/* LOOK AND FEEL */
body{

}

.form_table{
	width: 650px;
	margin-left: auto;
	margin-right: auto;
	border: 2px solid #CCCCCC;
	background: #FFF0A5;
	font-family: Lucida Grande,Tahoma,Arial,sans-serif;
	font-size: 12px;
	color: #000000;
	overflow: hidden;
}

.form_table a{
	color: #000099;
}

.outside a{
	color: #000099;
}

.form_table a:visited{
	color: #000099;
}

.outside a:visited{
	color: #000099;
}

.form_shadow_top{
	display: block;
}

.form_shadow_bottom{
	display: block;
}

.segment_header{
	margin: 1px;
	padding: 22px 0 18px 0;
	color: #FFFFFF;
	background: #8E2800;
	width: auto;
	background-repeat: repeat;
}

.q{
	padding: 10px;
	margin-bottom: 1px;
	margin-left: 1px;
	float: left;
	display: block;
}

.q .question{
	font-weight: bold;
}

.q .left_question_first{
	width: 15em;
}

.required .icon{
	background-image: none;
	background-position: left;
	background-repeat: no-repeat;
	font-size: 13px;
	padding-left: 14px;
}

.q .text_field{
	border: 1px solid #999999;
	color: #000000;
	margin: 1px 0;
	padding: 2px 1px;
	
}

.q .file_upload{
	background: #F4F4F4;
	border: 1px solid #999999;
	color: #000000;
	margin-top: 1px;
}

.q .file_upload_button{
	margin-top: 2px;
	border-color: #999999;
	clear: left;
}

.q .file_upload_button:hover{
	border-color: #444444;
}

.q .inline_grid td{
	padding: 5px;
	vertical-align: baseline;
}

.q .drop_down{
	background: #F4F4F4;
	border: 1px solid #999999;
	color: #000000;
	margin: 1px 0;
	padding: 1px;
}

.q .matrix th{
	color: #FFFFFF;
	background: #8E2800;
	padding: 5px;
	font-weight: bold;
	text-align: center;
	vertical-align: bottom;
}

.q .matrix td{
	padding: 5px;
	text-align: center;
	white-space: nowrap;
	height: 26px;
	border-bottom: 1px solid #999999;
	border-top: 1px solid #999999;
}

.q .matrix td.question{
	border-right: 1px solid #999999;
	font-weight: normal;
}

.q .matrix .multi_scale_sub th{
	font-weight: normal;
	border-top: 1px solid #999999 !important;
	background: #A32E00;
}

.q .matrix .multi_scale_break{
	border-right: 1px solid #999999;
}

.q .matrix_row_dark td{
	color: #000000;
	background: #FFF9D9;
}

.q .matrix_row_dark td.question{
	color: #000000;
	background: #FFF6C7;
}

.q .matrix_row_light td{
	color: #000000;
	background: #FFFBE5;
}

.q .matrix_row_light td.question{
	color: #000000;
	background: #FFF9D9;
}

.q .rating_ranking td{
	padding: 5px;
}

.q .scroller{
	border: 1px solid #CCCCCC;
}

.highlight{
	background: #ffb03b;
}

tr.highlight td{
	background: #ffb03b !important;
}

.outside{
	color: #FFFFFF;
	font-family: Lucida Grande,Tahoma,Arial,sans-serif;
	font-size: 12px;
}

.outside_container{
	width: 650px;
	padding: 1em 0;
	margin-left: auto;
	margin-right: auto;
	text-align: center;
	color: #FFFFFF;
	font-family: Lucida Grande,Tahoma,Arial,sans-serif;
	font-size: 12px;
}

.outside_container .submit_button{
	color: #000000;
	
	border-style: solid;
	border-width: 1px;
	border-color: #000000;
}

.outside_container .submit_button:hover{
	border-color: #444444;
}

.outside_container .progress_bar{
	background: #8E2800;
	margin: 0;
}

</style>
  
   </head>
<body>
     <div id="art-page-background-gradient"></div>
    <div id="art-page-background-glare">
       <div id="art-page-background-glare-image"></div>
    </div>
    <div id="art-main">
                <div class="art-Sheet">
                <div class="art-Sheet-tl"></div>
                <div class="art-Sheet-tr"></div>
                <div class="art-Sheet-bl"></div>
                <div class="art-Sheet-br"></div>
                <div class="art-Sheet-tc"></div>
                <div class="art-Sheet-bc"></div>
                <div class="art-Sheet-cl"></div>
                <div class="art-Sheet-cr"></div>
                <div class="art-Sheet-cc"></div>
                <div class="art-Sheet-body">
                    <div class="art-Header">
                        <div class="art-Header-png"></div>
                        <div class="art-Header-jpeg"></div>
                        <div class="art-Logo">
                            <h1 id="name-text" class="art-Logo-name"><a href="#">Confiteria Fuentes</a></h1>
                            <div id="slogan-text" class="art-Logo-text"></div>
                        </div>
                    </div>
                  
                <jsp:include page="ClienteMenu.jsp"/>
                <div class="art-contentLayout">
<form>
<div style="display:none;">
<input type="hidden" name="locid" id="locid" value="744762-0" />
<input type="hidden" name="EParam" id="EParam" value="AT1kKIiyxDzy+UEEoU6Jronjqh0+izcTjAIzAAWZiU8DVidljWd+ZYDf3xbzrtOu" />
<input type="hidden" name="FormId" id="FormId" value="FormResult" />
<input type="hidden" name="ElapsedTime" id="ElapsedTime" value="0" />
<input type="hidden" name="Referrer" id="Referrer" value="" />
<input type="text" name="subject_line" />
</div>


<!-- BEGIN_ITEMS -->
<div class="outside_container form_shadow_top">
<div class="form_shadow_top_left"><div class="form_shadow_top_right"><div class="form_shadow_top_middle"></div></div></div>
</div>
<div class="form_table">

<div class="clear"></div>

<div id="q14" class="q full_width">
<a class="item_anchor" name="ItemAnchor0"></a>
<div class="segment_header"style="width:auto;text-align:Center;"><h1 style="font-size:18px;">Registro En Linea</h1></div>
</div>

<div class="clear"></div>

<div id="q15" class="q full_width">
<a class="item_anchor" name="ItemAnchor1"></a>
<div class="full_width_space"><div>Aqui podras registrarte de forma gratuita. Es totalmente gratis, y podras disfrutar de muchos otros beneficios por ser nuestro cliente estrella.</div></div>
</div>

<div class="clear"></div>

<div id="q18" class="q required">

<a class="item_anchor" name="ItemAnchor2"></a>
<label class="question top_question" for="RESULT_TextField-2"><b>*</b> Identificacion</label>
<input type="text" name="RESULT_TextField-2" class="text_field" id="RESULT_TextField-2" size="25" maxlength="255" value="" />
</div>

<div class="clear"></div>

<div id="q16" class="q required">
<a class="item_anchor" name="ItemAnchor3"></a>
<label class="question top_question" for="RESULT_TextField-3"><b>*</b> Nombre</label>
<input type="text" name="RESULT_TextField-3" class="text_field" id="RESULT_TextField-3" size="25" maxlength="255" value="" />

</div>
<div id="q17" class="q">
<a class="item_anchor" name="ItemAnchor4"></a>
<label class="question top_question" for="RESULT_TextField-4">Segundo Nombre</label>
<input type="text" name="RESULT_TextField-4" class="text_field" id="RESULT_TextField-4" size="25" maxlength="255" value="" />
</div>

<div class="clear"></div>

<div id="q19" class="q required">
<a class="item_anchor" name="ItemAnchor5"></a>
<label class="question top_question" for="RESULT_TextField-5"><b>*</b> Apellido</label>
<input type="text" name="RESULT_TextField-5" class="text_field" id="RESULT_TextField-5" size="25" maxlength="255" value="" />

</div>
<div id="q20" class="q required">
<a class="item_anchor" name="ItemAnchor6"></a>
<label class="question top_question" for="RESULT_TextField-6"><b>*</b> Segundo Apellido</label>
<input type="text" name="RESULT_TextField-6" class="text_field" id="RESULT_TextField-6" size="25" maxlength="255" value="" />
</div>

<div class="clear"></div>

<div id="q21" class="q required">
<a class="item_anchor" name="ItemAnchor7"></a>
<label class="question top_question" for="RESULT_TextField-7"><b>*</b> Direccion</label>

<input type="text" name="RESULT_TextField-7" class="text_field" id="RESULT_TextField-7" size="70" maxlength="255" value="" />
</div>

<div class="clear"></div>

<div id="q22" class="q">
<a class="item_anchor" name="ItemAnchor8"></a>
<label class="question top_question" for="RESULT_TextField-8">Telefono</label>
<input type="text" name="RESULT_TextField-8" class="text_field" id="RESULT_TextField-8" size="25" maxlength="255" value="" />
</div>
<div id="q23" class="q">
<a class="item_anchor" name="ItemAnchor9"></a>
<label class="question top_question" for="RESULT_TextField-9">E-Mail</label>
<input type="text" name="RESULT_TextField-9" class="text_field" id="RESULT_TextField-9" size="25" maxlength="255" value="" />
</div>

<div class="clear"></div>

<div class="q required"><b>*</b> Campos Requeridos
</div>
<div class="clear"></div>
<div align="center"><input  type="button" name="Submit" value="Guardar" class="submit_button" id="FSsubmit" />
</div>
</div>
<br/>
</form>
            </div>
             </div>
             </div>
                </div>
         
     </body>
</html>
